Abulia
Abulia
Abulia (aboulia) is a "syndrome of hypofunction", characterized by lack of initiative, spontaneity and drive (aspontaneity), apathy, slowness of thought (bradyphrenia), and blunting of emotional responses and response to external stimuli. It may be confused with the psychomotor retardation of depression and is sometimes labeled as "pseudodepression." More plausibly, abulia has been thought of as a minor or partial form of akinetic mutism. There may also be some clinical overlap with catatonia. Abulia may result from frontal lobe damage, most particularly that involving the frontal convexity, and has also been reported with focal lesions of the caudate nucleus, thalamus, and midbrain. As with akinetic mutism, it is likely that lesions anywhere in the "centromedial core" of the brain, from frontal lobes to brainstem, may produce this picture.
Pathologically, abulia may be observed in:
- Infarcts in anterior cerebral artery territory and ruptured anterior communicating artery aneurysms, causing basal forebrain damage.
- Closed head injury
- Parkinson’s disease; sometimes as a forerunner of a frontal lobe dementia
- Other causes of frontal lobe disease: tumor, abscess
- Metabolic, electrolyte disorders: hypoxia, hypoglycemia, hepatic encephalopathy
Treatment is of the underlying cause where possible. There is anecdotal evidence that the dopamine agonist bromocriptine may help.
References
Abdelgabar A, Bhowmick BK. Clinical features and current management of abulia. Progress in Neurology and Psychiatry 2001; 5(4): 14,15,17
Bhatia KP, Marsden CD. The behavioral and motor consequences of focal lesions of the basal ganglia in man. Brain 1994; 117: 859-876 Fisher CM. Abulia. In: Bogousslavsky J, Caplan L (eds.). Stroke syndromes. Cambridge: CUP, 1995: 182-187
Cross References
Akinetic mutism; Apathy; Bradyphrenia; Catatonia; Frontal lobe syndromes; Psychomotor retardation
